inconsistencies in geriatric uti management in long term care
TRANSCRIPT
DePaul University DePaul University
Via Sapientiae Via Sapientiae
Grace Peterson Nursing Research Colloquium 2017
Nov 17th, 10:00 AM - 11:30 AM
Inconsistencies in Geriatric UTI Management in Long Term Care Inconsistencies in Geriatric UTI Management in Long Term Care
Wilsy Abraham [email protected]
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Abraham, Wilsy, "Inconsistencies in Geriatric UTI Management in Long Term Care" (2017). Grace Peterson Nursing Research Colloquium. 49. https://via.library.depaul.edu/nursing-colloquium/2017/Fall_2017/49
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References: Juthani-Mehta, M., Quagliarello, V., Perrelli, E., Towle, V., Van Ness, P., & Tinetti, M. (2009). Clinical features to identify urinary tract infection in nursing home residents: a cohort study. Journal Of The American Geriatrics Society, 57(6), 963-970. doi:10.1111/j.1532-5415.2009.02227.x. Lim, V., Whitehurst, T., Usoro, E., & Ng, S. (2014). Management of urinary tract infections in elderly patients: strategies for improvement. BMJ Quality Improvement Reports. doi: 10.1136/bmjquality.u203314.w1503 . Rowe, T. & Mehta, M. J. (2013). Urinary tract infection in older adults. HHS Public Assess, 9(5).
The purpose of this study was to identifiy barriers in adherence to the management of UTI and how effective protocols can benefit the geriatric population.
Inconsistencies In Geriatric UTI Management & Protocol In Long Term Care
Wilsy Abraham, MSN Dr. Elizabeth Hartman, PhD, RN
UTI occurs when pathogens colonize periurethral area and ascend through the urethra upwards towards the bladder and then towards the kidney. Infection of the renal parenchyma causes an inflammation known as pyelonephritis. If inflammation continues it can lead to interstitial edema from tubular obstruction. It is most commonly caused by enteric gram-negative aerobic bacteria.
This is important in regards to nursing because nurses are often responsible for identifying the early symptoms of UTI and advising physicians with recommendations on how to manage the patients. Further education in recognizing signs and symtoms in the elderly population, diagnosing correctly, and adhereing to management protocol will be beneficial.
Literature reviewed was from the following databases: CINAHL Complete, PubMed, and UpToDate. Search terms included: urinary tract infection, elderly, and management. A total of nine review articles were used for the literature review.
Over 4 million Americans are admitted to long term facilities each year and around 1 to 3 million serious infections occur each year in these facilities. Urinary tract infections are considered the most common infection among long-term care settings, with studies reporting a 28-day mortality of 5%. The most recent evidence-based research indicates recommendations that support reduction of UTIs in LTC setting. Such infections are associated with extended hospital stays, re-hospitalization, and significant healthcare expenses. Many barriers have been identified in assessing, diagnosing, and treating patients with UTI causing inconsistencies in protocols.
INTRODUCTION PURPOSE
CONCLUSION
NURSING IMPLICATIONS
METHODS
As this high-risk population grows at a rapid rate, it’s important for health care workers to be sensitive to the management protocol for UTI. It is the most common reason for antibiotics to be prescribed at LTC setting. Healthcare providers have a responsibility to appropriate UTI management in this understudied, growing population. Educational activities for providers are needed in relation to antibiotic prescribing for UTI and appropriate protocols need to be in place.
RESULTS
Conceptual Framework: TheTannahillModelisaninterven0on-basedmodelthathasthreeoverlappingthemes:healtheduca0on,diseasepreven0on,andhealthprotec0on.Thismodelsupportseduca0ngnursingandotherhealthprofessionstorecognizeandproperlydiagnoseUTIearly,preven0ngcomplica0onfromUTIandprovidinghealthprotec0on.
In reviewing the literature results, barriers surrounded adherence to UTI management protocol. These included : lack of awareness, no guidelines visible on units, foley catheters, misdiagnoisis, mode of administration, duration of treatment, and clinical features. The usual protocol includes: TMP/SMX, nitrofurantoin, amoxicillin or cephalosporin, urine culture follow-ups.
4 5
PATHOPHYSIOLOGY
Proposed Diagnostic Algorithm for UTI